Transverse maxillary deficiency is relatively prevalent in orthodontic patients. This article reports the use of a Miniscrew-Assisted Rapid Palatal Expansion (MARPE) device for the correction of transverse skeletal maxillary constriction in an adult patient. The patient was a 20-year-old girl with a transverse maxillary deficiency and bilateral posterior crossbite. A MARPE device was positioned on her palate using 4 miniscrews. The activation protocol was one-quarter turn per day every other day, with a total activation duration of 10 weeks following with a 3-month retention period. Pre-MARPE and post-MARPE cone-beam computed tomography cross sections presented a skeletal expansion of maxilla. This report confirms the effective treatment of a mature patient with severe maxillary constriction, highly deep palate, and posterior crossbite using a custom-made modification of MARPE

Statement of the Problem: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported.Purpose: This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children.Materials and Method: A sensitive search of electronic databases of PubMed (since 1966), SCOPUS (containing EMBASE, since 1980), Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings (MeSH) keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included.Results: Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 (28.12) months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval (CI) 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk (RR): 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep (RR: 5.1, CI 95%: 1.44-18.04) significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model.Conclusion: Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce (Level of evidence: C).

Background: Rapid maxillary expansion (RME) is an important method for correcting maxillary transverse deficiency. Objectives: The aim of this study was to assess the variations of the palatal plane in the anteroposterior and vertical directions after RME observed under cone-beam computed tomography. Methods: The images using the cone-beam computed tomography were obtained from the skull of 15 patients (10 males, 5 females) with ages from 7 to 14 years, at the specialization course in orthodontics of the School of Dentistry at UFBA before (T0) and after (T1) RME using the Haas-type expander. The sagittal slices were obtained with Dolphin imaging program, premium version 11. 0, in order to visualize the most anterior and posterior extremities of the maxillary bone and the following points: Sella (S), nasion (N), anterior nasal spine (ANS) and posterior nasal spine (PNS). The distances between points S and PNS (L1) and between N and ANS (L2) and the angles formed by the intersection of line SN with the palatal plane (angle 1) and line SN with line N-ANS (angle 2) were measured. Results: The values obtained were statistically analyzed using Students t-test. At the time intervals assessed, no statistically significant difference was found in the linear measurements L1 and L2 (P = 0. 296 and P = 0. 674, respectively). No statistical significance was found when assessing angles 1 and 2 (P = 0. 673 and P = 0. 589, respectively). Conclusions: RME using the Haas-type expander does not cause any alterations in the vertical or sagittal position of the maxilla.

Posterior crossbite is relatively common in children. Early treatment produces desirable occlusion, as well as increasing the arch perimeter. The purpose of this study was to examine the relationship between palatal expansion and maxillary arch perimeter.A group of 12 children aged 8-10 years, with posterior dentoalveolar crossbite, were selected for this study.All cases were treated for their crossbite using a removable palatal expander. Changes in both intermolar width of maxillary second primary and first permanent molars were compared to changes in arch perimeter at the end of treatment.Results of this comparison using paired t-test revealed that by increasing the arch width, a significant increase could be seen in arch perimeter (p<0.001).Regression analysis revealed that by increasing intermolar width (second primary molar) , arch perimeter also increases. However, this correlation was not statistically significant and there was no linear relationship between these two parameters too. On the other hand, the same analysis showed that a significant correlation existed between changes in intermolar width ( first permanent molar) and changes in arch perimeter (p=0.027). There was also a linear relationship between these two parameters.conclusion: 1mm increase in intermolar width ( maxillary first permanent molar) will cause a mean increase of 0.96 ± 0.31 mm in arch perimeter and this change in arch perimeter must be considered in space analysis in patients with posterior crossbite.

Maxillary expansion has prevalent use in orthodontics. The aim of this study was to evaluate the efficiency of removable appliance in rapid palatal expansion. 11 patients with posterior cross bite who had a mean age of 107 months were treated. Each appliance had an expansion screw and posterior bite plate. The patient advised to open the screw one time per day. After preparation of pre and post- treatment casts, photographs, occlusal X-rays and Lateral cephalograms were requested, 28 Linear and angular parameters were measured from preand post treatment cephalograms which were compared by paired t.test.1- Based on occlusal X-ray removable appliance in 75% could open the maxillary suture.2- Point a moved to anterior.3- There was no significant rotation in the jaws.4- Palatal plane did not translate down but anterior lower facial height was increased.5- Anterior upper and lower teeth did not show significant differences.We find that such removable expansion appliance is efficient, specially in the long face cases that have tendency to open bite. The important factors in treatment with removable expansion appliances are patient cooperation and good appliance retention.

Purpose: Treatment of patients with class III malocclusion is one of the most challenging problems in orthodontic practice. This problem which causes functional and esthetic problems can result from prognathism of mandible or deficiency of nasomaxillary complex or a combination of both. It has been estimated that the incidence of this type of malocclusion in Iranian population is between 7.22- 19.5 percent. The importance of early identification and treatment of this malocclusion is significant. The aim of this study was to determine the cephalometric changes following combined use of rapid maxillary expansion and facemask therapy in class III malocclusion.Methods & Materials: In this quasi experimental prospective clinical trial, 15 Iranian patients (6 males and 9 females with a mean age of 8.6 years) were selected. They were first treated with rapid maxillary expansion for 14 days prior to facemask delivery. Then facemask therapy was initiated untill normal canines and molars relationship and a normal overjet were achieved. Cephalometric means (consist of 11 angular and 8 linear measure) before and after treatment was calculated and compared with paired t-test to determine significant differences.Results: Cephalometric analysis showed following changes:SNA=1.3±1.6, SNB=-0.5±1.6, ANB=1.7±2.3, Gonial Angle=-1.4±4.1, Articular Angle=-6±27.5, SNPog=-0.7±1.7, Inclination Angle=2.3±7.3, Y axis Angle=1.5±3.4, Mandibular Plan Angle=2.3±3.3, Occlusal Plan to SN=1±5.4, NSAr=0.8±2.3, PFH/AFH=0.8±1.9,N┴LFH to A=1.1mm±1.9, N┴LFH to Pog=1mm±4.6, Maxilla length=2.3mm±2.9, Mandible length=0.4mm±0.8, Overjet=3.8±2.7, Overbite=-0.8mm±1.5, Wit's appraisal=2.4±2.5.Conclusion: This result indicate that facemask and rapid maxillary expansion improve class III malocclusion by increase in maxillary growth in anterioposterior dimension and a slight limitation of mandibular growth.

Introduction: This study was performed to compare the effects of single and multiple irradiations of low-level laser therapy (LLLT) on bone regeneration in a mid-palatal suture following rapid palatal expansion (RPE). Methods: In this animal study, 40 male Wistar rats underwent RPE for 7 days and were divided into 4 groups including A: single LLLT on day 7, B: Multiple LLLT on days 7, 9, 11, 13 and 15, C: control (no LLLT), and D: sacrificed on day 7. Animals in group D were used to determine the amount of suture expansion. LLLT was done by a diode laser set at an 808 nm wavelength with a useful power output of 100 mW and duration of 0. 1 ms. LLLT was applied to three points. After three weeks of retention, the rats were sacrificed and beheaded and the maxilla was evaluated by occlusal radiography, µ-CT, and histomorphometric analyses. A comparison of the mean measurements between the groups was performed using ANOVA and the Tukey post hoc test. Results: Based on occlusal radiography and µ CT, bone density in group B was significantly higher than group A and group C (P < 0. 05). There was no significant difference in bone density between group A and group C (P > 0. 05). Mean suture width (MSW) in group B was significantly lesser than the control group (P = 0. 027) while there was no significant difference between MSWnin groups A and B (P = 0. 116) and groups A and C (P = 0. 317). Conclusion: It may be concluded that multiple low-power laser irradiation improves bone regeneration after RPE while single irradiation does not have a positive effect.

Introduction: Crossbite is a common malocclusion with a 7-23% prevalence rate. Treatment is based on the expansion of the mid-palatal suture (MPS) with Rapid Palatal Expansion(RPE) followed by a retention period to reach new bone maturation, enough to maintain the results stable. This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in increasing bone formation in MPS. Methods: This article was written by the PRISMA checklist. Electronically, 3 databases, namely PubMed, Scopus, and Embase, were searched with the keywords selected based on PICO. Time (2010-2021) and language restrictions were performed. Results: 528 articles, out of which 374 studies were screened, were found, and 9 full-text articles were subsequently included considering these inclusion criteria: randomized clinical trial (RCT) that examines the efficacy of LLLT in rapid palatal expansion (RPE), age under 15 years, non-surgical RPE with a tooth-supported appliance, and low-intensity laser application. Finally, 4 articles were appraised by Cochrane version 5. 2. 0 with 7 domains. 3 of 4 articles showed LLLT has a significant impact on bone formation. One of them showed no significant difference in pain perception and bone density between the laser and non-laser groups. Conclusion: While many studies have assessed the effect of LLLT on bone formation in animal models, high-quality clinical trials are missing in this regard. The available clinical trials suggest a positive effect of LLLT on sutural bone formation after RPE.